As physicians, our primary goal is to provide the best possible care to our patients. However, even with the best intentions, medical gaslighting can occur, leading to patient distress and potentially harmful outcomes. Medical gaslighting is not often intentional. It can happen when physicians, under time constraints, facing diagnostic challenges, or burnout, inadvertently invalidate a patient's symptoms or concerns.
Just a few years ago, I found myself on the other side of the exam room. The fatigue felt like gravity had been turned to the maximum level, I had dry eyes and a dry mouth. I told my primary care physician was worried about Sjogren’s and she replied “I guess we can order the blood work, but I think you’re fine.” Thankfully, I had the privilege of knowing she was otherwise a nice and competent physician but consider our patients who are not able to give the benefit of the doubt or have experienced medical trauma. It’s a bit easier to see how such instances could further erode patients' trust. We know that negative interactions can lead to delayed diagnoses and appropriate treatment. This is especially true in chronic and invisible conditions where symptoms are often subjective and varied like pain and fatigue.
Strategies for Conscious Care
- Active Listening while Channeling Curiosity: Prioritize listening to learn from your patients. Encourage them to describe their symptoms in detail, and avoid interrupting or jumping to conclusions. “Can you explain how fatigue is impacting your life?”
- Emphasize Empathy and Validated Lived Experiences: A simple acknowledgment of their distress can go a long way in building trust. “I can see you are really hurting” Also, I take a few cleansing deep breaths between visits to help me reset and recharge in order to be more present with each patient.
- Thorough Assessment As A Team: Ensure a comprehensive assessment, especially in cases with non-specific symptoms, by taking a detailed history, physical examination, and appropriate investigations. I will often ask if there is a particular diagnosis or testing they had in mind so that we can take that into consideration as we come up with a plan together.
Building Trust in Patient Relationships
Transparent Communication: Be honest about uncertainties in diagnoses or treatment plans. Patients being part of the decision-making process and know the office ground rules for communication between visits too.
Continual Education: Stay updated with the latest in medical research, particularly about conditions with complex presentations.
Collaborative Approach: Encourage a team approach not only with your patients but involving other specialists if necessary. A multidisciplinary perspective can be invaluable in complex cases.
Addressing the Challenges
Time Management: While time is often limited, try to allocate enough for each patient. Consider strategies like patient questionnaires to gather information efficiently and let patients know at the start of the visit the amount of time scheduled.
Reflective Practice & Prioritizing Clinician Wellness: Regularly reflect on patient interactions and what helps you show up fully in your work. Create boundaries to help ensure you remain healthy and seek mentorship from colleagues who are thriving.
Patient Education: Empower patients with educational resources. Informed patients are more likely to engage in meaningful discussions about their health.
By adopting these strategies, physicians can enhance patient care and reduce instances of medical gaslighting. Our goal is to provide compassionate, patient-centered care, ensuring all patients feel heard, respected, and involved in their healthcare journey.
How do you ensure your patients feel heard and understood in your practice?